AIBU - With this new data on obesity and the NHS is it time to have some honest and difficult conversations?

[IAmADancer]

New data from a ‘landmark study’ has show that obesity costs the NHS around 14billion a year and that 2 out of 3 adults are obese.

I know this is a difficult subject but the numbers are pretty clear. With the cost of living crisis and a general requirement for both parents to work now to support themselves how do we support people to make the right choices and tackle a growing problem?

Im really interested to hear people’s opinions on what we can do with such stark figures laid bare.

https://www.telegraph.co.uk/news/2023/05/17/cost-of-obesity-twice-those-who-are-healthy-nhs/

I agree that carbs can be delicious - but I am talking about obese people - not those who are healthy or slightly overweight. People whose health is massively at risk and who need to forfeit 'delicious' carbs/sugar or risk stroke, heart disease, diabetes etc.

And low carb has been shown to be helpful for diabetics - obesity being a main factor in type 2 / late onset diabets. This from Diabetes.co.uk;

Can the Atkins diet help diabetics?Dr Atkins was key in making the connection between obesity and insulin more widely spread. At this point, diabetes was often treated with a diet high in starchy carbs and sugar.
Atkins played an important role in understanding how restricting carbohydrates could result in more stable blood sugar and is an essential part of managing type 2 diabetes.

There was an advert on Facebook yesterday with a model who was very slim, the majority of female posts were mocking the woman in question for being slim and asking why they didn’t advertise overweight women, I looked on the company site and they did infact have models of a larger build.
Overweight has been normalised because of fat-shaming and if you’re slim/skinny it’s not normal. It’s appalling to see women mock a slim woman, if it was slim women mocking a larger woman, all hell would break loose.

I think in needs a holistic approach. Input from medical, fitness, psychological and sociological side. I say this as someone who is move that double what a healthy weight should be for my height.

I eat because I am lonely, stressed, previously couldn't afford the healthy options and now those bad habits are proving hard to break, a lack of support to the extent that people (colleagues especially) actively discourage me in attempts to get healthy, time restricted, lack of funds for investing in gym memberships/home equipment and lack of confidence to go out walking etc in public, my weight has made me more accident prone so for the last year I have almost constantly been recovering from some kind of injury.

I am very lucky I am not yet diabetic, but this means I'm not eligible for assistance from many NHS referral options. Don't worry though, whenever I go to a&e because I'm injured again, the doctors make sure to tel me how fat I am.

I keep trying. I'll never stop trying. But in my fat encrusted heart I know I probably won't see 40.

You should push for further investigations as that is absolutely not normal and there is undoubtedly something else going on if you are that active and are eating within calories.

I agree it's scary OP, it is complex though and the government should invest heavily in different areas if they want actual change. Although fundamentally (aside from the few are on meds that cause weight gain as to which the benefits of those meds will be greater than the risk of being overweight) it is a case of being more active and making more considered choices, for a plethora of reasons people struggle.

Some have disordered eating and seek comfort in food due to unresolved mental health reasons: invest in better support and easier access to therapy etc

Some don't know about nutrition- not surprising when even the NHS is a mess and outdated in its advice: free up time at school to make time for this (gov need to do this rather than teachers who have zero leeway)

Some can't afford to cook from scratch and make sensible choices- lot trickier to address, personally I think subsiding farmers and having fruit, veg, meat, dairy (and veggie and vegan options) become more affordable whilst paying them a fair wage may help at least a bit. Fruit and veg is cheap to be fair in many shops but meat is never cheaper than processed, salty nuggets or whatever else

Some don't have time/resources to exercise or cook etc. This would be the biggest shift I guess, as now people need more £ to live more people invariably commute in cars rather than can afford to walk locally and walk. Sports centres are pricey and often crap quality etc

The results of the study are not that surprising. It's a tough one, isn't it. Of course there are lots of people who take medication etc which affect weight. However, a lot of people aren't aware that putting on weight leads to what is often termed the metabolic syndrome i.e. high blood pressure, high cholesterol and type 2 diabetes. These are preventable but for too long we've been believing there is such thing as 'healthy overweight', i.e. as long as you eat healthily and/or exercise.

So, when people get these issues - high BP, cholesterol, t2 diabetes - they're put on a cocktail of medicines, such a viscous circle. But lots of studies have also shown that a change in diet (and losing weight) can reverse it not all most of the symptoms.

The NHS was talking about prescribing exercise / diet as therapy ahead of medicines. I think this needs to happen and we need to be aware that putting on weight (especially for apple shaped people, i.e. around the middle) is really unhealthy. Needs to start with monitoring and help when children are young.

Walked to school and now have SUV and park as close to Supermarket as I can get!

They dodge refined carbs though. The mediterranean diet is about 50% carbs / 200 grams carbs daily but very little white bread/white pasta. And very litte refined sugar.

47% of Italians are overweight or obese.
I lived in Italy for years. Italian bread is inedible white shite that needs to be drenched in oil to make it even vaguely palatable. And most Italians don't make their own fresh egg pasta they live on the same dried stuff that we use. And they eat tons of it - as well as polenta.

It’s clear that losing weight for many people isn’t just going to be achieved by telling them to stop being greedy as basically doctors and society does. It’s clear obesity is the visible symptom of issues such as trauma, stress, undiagnosed ADHD, depression, gut health and diversity of gut bacteria, genetics, economics, other health conditions, stress, hormones.

if we want to sort out a lot of the obesity issue we need to address peoples mental health first and foremost, we need to understand why people’s gut health and hormones appear to be increasingly problematic. We need to solve the cost of living crisis to get access to better food, reduce stress and working hours.

obesity is the symptom of an unwell society humans are living how they were never meant to live, it is killing us mentally and physically.

We cannot keep blaming the individual and telling them to sort everything out, we need to start healing holistically.

if society continues how it is we’re just going to get sicker and sicker as we can’t cope.

At this stage anyone just blaming the obese person is an uneducated fool (prob why doctors keep doing it)

More help to prevent children becoming overweight as once the bad habits are formed and the weigh is gained it's almost impossible for people to change

Come down hard on parents who don't care for their children well

@dumple

me too. I rarely have fast food or takeaways, I rarely drink alcohol or fizzy drinks. We don’t have puddings after meals. I go to the gym three times a week, I have an allotment.
I do have a bad latte habit.
I don’t drive so walk pretty much everywhere, interesting people here advocating that people should walk more and address the ‘driving culture’ when on other threads non drivers are ripped to shreds for not being adults.
I don’t take any medications which cause weight gain. In fact at this point I am actually quite healthy with no obseity related conditions.
I have been overweight my whole life.
The only time I have ever lost significant weight is when I was single and childless so spent a huge amount of time and effort managing it all.

I know I am obese, shaming or bullying me will not work. Unlike smoking or drinking, fat people have to consume the very thing which causes the problem.
Obesity is a complex issue, there are no easy answers.
I am leaving work in a week, and have about a month off. I do intend to focus on my overall health and well being. It will be interesting to see what I can achieve when I have literally nothing else to think about but diet and exercise.

It’s true though. Low fat spread is an ultra processed food. So is your hovis sliced bread and your sugar free flavoured water.

As an example, here are the ingredients in Bertoli light spread:

• Water, Vegetable Oils (28%) (Rapeseed, Palm), Olive Oil (10%), Modified Corn Starch, Salt, Emulsifiers (Mono- and Diglycerides of Fatty Acids, Lecithin), Preservative (Potassium Sorbate), Buttermilk (Milk), Acid (Citric Acid), Natural Flavouring, Vitamins A and D, Colour (Carotenes)

In comparison, butter just contains milk (and sometimes salt).

I’m not saying your diet is the reason you’re over weight. I’ve read all of your posts and your situation is very difficult. But we are increasingly starting to understand just how damaging ultra processed food is for our body and what a massive role it plays in the obesity epidemic.

But this is all beside the point. The OP is talking about obesity at a population level. There will always be cases where people are genuinely obese through no fault of their own due to physical or mental ill health. But these people are in the minority. Most people are obese due to their life choices or for socioeconomic reasons (lack of education to support healthy choices, difficulty accessing healthy choices etc). These are things that can and should be fixed.

It's also the responsibility of the manufacturers of these Ultra Processed Foods (UPFs). They need to start listening to the research/scientists who are finding that it's not necessarily the ingredients that make up the UPF's, it's the actually processing of the ingredients that is causing higher rates of obesity. UPF's are addictive and that is what the manufacturers have caused; personally, I think they are answerable to a lot (not all) of the issues we now face.

This and there is compelling research that the calories in/out model is very flawed. Also exercise doesnt have a huge impact on weight loss. Im reading Prof Tim Spektors book spoonfed and he has looked at hundreds of studies to debunk myths like these. Exercise is very good for us in terms of mental well being and preventing insulin resistance and keeping our heart strong but not for weight loss.

I've seen amazing results from people going on lower carb (not Atkins - too severe) diets and changing their lifestyle. Too many people think exercise will make them lose weight. It rarely does. Start with the weight unless you feel you can do both!

Carbs = sugar, whether from a vegetable, fruit or sugar. Obviously veg/fruit healthier in other respects but, essentially too much sugar leads to inflammation in the body too.

Introduce yoghurt, lean protein, eat little/often if it suits you combined with protein shakes. It's not easy but losing weight from the abdomen is essential to control BP/cholesterol/diabetes (2).

If all the people who CAN do something about their obesity did so, the number of obese people would go down. A LOT.
Has anyone one in RL who knows you actually insinuated that your obesity is down to being lazy, eating fast food and guzzling coke?

Steroids are well known to cause huge weight gain, even in previously sylph~like figures.

However, not everyone has this type of weight gain..It's lifestyle, and eating too much of the wrong type of food with not enough exercise.

I truly believe the way humans are living right now isn’t healthy. The long work weeks, processed foods, being glued to our phones. It’s no wonder we have an obesity problem and it is very sad.

I’m hoping things change and get better. I don’t have any real suggestions, I hope it gets better. But the cost of living crisis surely is making this so much worse - buying of cheaper processed food, depression etc must be sky rocketing. It makes me so so sad!

Obesity isn't the inevitable response to stress , low income adhd etc as they have been around for centuries

What has changed is you can now buy addictive crap "food" very cheap

What has happened is that people are spending less of their income on food and more on everything else - priorities

What has changed is we drive everywhere
And sit to work
And work long

Chorleywood bread should be banned, UPF that sometimes pretends to be healthy. The much maligned national loaf would be better, it had genuine nutritional value, for manual workers especially.

Better education is needed around food. Much food that is touted a healthy is not (low fat spread, I'm looking at you), especially if it makes healthy claims on the packaging, butter, dripping or olive oil would be better.

NHS dieticians are not allowed to suggest a diet incorporating the latest research but if you ask them directly you may not be able to stop them. I got one of my clients to ask about sweeteners and the body's response cue an impromptu rant about how the liver and pancreas are not wonderfully intelligent and can't sort sugar sweet from artificial sweet, which leads to an insulin release which will eventually cause insulin resistance. I was well impressed, she knew her stuff but was discouraged from using it.

People like eating UPFs, the adverts tell them it is healthy. Decades of big industry diet culture has negatively influenced our relationship with food, in particular women's relationship with food.

I park as close to the door as possible at the supermarket because I'm disabled. I'd assume many other BB holders are similar.

If faecal transplants can make thin people fat due to the introduction of a new gut biome, could it work the other way round?
Could obese people potentially be treated with healthy gut biome materials?
It would be interesting to see.

Honest and difficult conversations already happen.

As smoking is very difficult for most to quit, weight loss at the level of obesity is not simple and straightforward and most will struggle.

Agree with this. Healthy food needs to be cheap and convenient. Cycling paths need to be safe, easy to access and they need to be useful for commuters and shoppers as two policy ideas.

Invest in safe, usable (!) bike paths and public transport
Pedestrianise town centres
Run free exercise classes, boot camps, running events in the public parks
Offer free or cheap gym and swimming pool memberships
Force larger employers to pay their staff to exercise and provide the equipment for it
Run live healthy campaigns similar to the anti-smoking campaigns in the 90ies and 00ies
Teach school children to cook nutritious meals and source the ingredients for them
Make daily PE / games part of the curriculum
Tax junk food and limit how much junk food shops are allowed to sell and where they can display it